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1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS:916 Pacific Ave Everett,WA 98201 PROPERTY TAX# PERRY#_, <br /> & 'f-con. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER PRMC Phone/E-mail <br /> Address 1100 Pacific AVE Everett, WA 98201 City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent X Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Burns Fire Protection Systems State Lic.# BURNSFP841 DU City Bus.LicgS-Cli c0 <br /> Address P.O. Box 1110 Granite Falls, WA 98253 Phone/Email 425-905-5780/Keith@burnsfire.com <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PRMC Fetal.Monitoring Clinic, Keith Kyle: 425-905-5780/Keith@burnsfire.com <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION ' CONTRACT PRICE OF WORK I//0'. 'Q) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: Single Family Duplex_Townhouse Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign )(Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back):-Refeee a/adding ii sprinkler heads for the new tenant space <br /> eliCITIN <br /> MECHANICAL PERMIT APPLICATION PLUMBING PER IT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> NKLER/SUPPRESSION SYSTEM Other: <br /> iI Number of Heads W4.1/A. Other: <br /> I ereby certify t.:t I have read and examined is .. cation and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comps <br /> wheth: pecified herein or not.The g tin! . •permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized b e owner of rope .perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Aut rize gent i +re Date (Revised 9/2014) <br />